Mar 7, 2023
Governor DeSantis’ Bold Leadership is an Example to Other States Seeking to Stop PBMs from Profiteering Off Consumers, Employers and Taxpayers
WINSTON SALEM, NC (March 7, 2023) – Pharmacists United for Truth and Transparency (PUTT) commends Florida Governor Ron DeSantis for taking swift, decisive action to rein in the largest pharmacy benefit managers (PBMs) who currently engage in profiteering practices that drive up the cost of prescription drugs for patients and their employer-sponsored health plans, while also pushing small business pharmacies to the brink of closure.
“We are delighted to see Governor DeSantis standing up for his state,” said PUTT Executive Director Monique Whitney. “Consumers, taxpayers, large and small employers - we’re all targets of these cowardly, invisible middlemen who punch from behind then run for cover and lie about their actions when held to account. Governor DeSantis is drawing a line in the sand, and Florida’s healthcare will greatly benefit as a result.”
PBMs - now attempting rebrand themselves as pharmacy benefit companies or PBCs - are the controversial prescription drug middlemen now implicated in several state Medicaid studies for overcharging states by multiple hundreds of millions of dollars while reimbursing pharmacies for less than drug acquisition cost, resulting in hundreds of community pharmacies closing each year in the U.S. As “pharmacy deserts” emerge in large and small communities, state regulators and legislators have increased scrutiny.
PBMs have also drawn sharp criticism for interfering in patient care, often inserting requirements to “fail first” on other medications before being allowed access to the medication prescribed by their doctor or requiring multiple prior authorizations before a pharmacist can dispense the medication. PBMs requiring patients to engage in “fail first” therapy (also called “step therapy”) often receive financial incentives from the “fail first” medications, while pointing the finger at patients’ employers as justification for requiring one or more prior authorizations to receive prescribed medications.
“For patients with cancer, PBM involvement is especially problematic ,” said Dr. Paresh Patel, an oncologist with Florida Cancer Specialists and Research Center. “There is no ‘one size fits all’ treatment protocol for cancer and time is of the essence. Delays can be devastating for patients, and for oncologists, it’s a bureaucratic nightmare. We’re encouraged by Governor DeSantis’ proposed reforms and thank him for taking charge at a time when leadership in healthcare policy is critically needed.”
Key components of the Governor’s plan include prohibiting spread pricing, ending reimbursement clawbacks and “transaction fees” for pharmacies (requiring pharmacies to pay PBMs for each and every claims submitted for reimbursement) and addressing the problem of patient steering - anti competitive actions resulting in dramatic and avoidable drug price hikes and increased health insurance premiums.
“Governor DeSantis’ reforms are the equivalent of the cavalry coming to the rescue,” said Johnny Meier, owner of My Community Pharmacy, an independent pharmacy based in Boynton Beach, FL. “ Community pharmacies have worked closely with lawmakers and patients to help educate the public about the need to draw out these invisible pharmacy predators who’ve been engaged in shameless profiteering for more than two decades. It’s not just about the money, it’s about the massive breach of trust they’ve created. It’s time they’re held to account and we know Governor DeSantis will get the job done.”
For more information about Florida’s community pharmacy advocacy efforts, see SPARFL.org. To understand how PBMs interfere in critical patient care, visit the Community Oncology Alliance (CommunityOncology.org) or for additional in-depth information about how PBM practices are obstructing patient care while driving up costs to consumers and end payers, visit TruthRx.org.
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